肠空气瘘伴腹壁毁损外科重建策略  

Surgical reconstruction strategies for enteroatmospheric fistula accompanied by abdominal wall defects

作　　者：吴秀文 刘野 张锦鹏 任建安 WU Xiu-wen;LIU Ye;ZHANG Jin-peng;REN Jian-an(Research Institute of General Surgery,Jinling Hospital,Affiliated Hospital of Naning University,Nanjing 210002,China;Medical School of Southeast University,Nanjing 210009,China)

机构地区：[1]南京大学医学院附属金陵医院,中国人民解放军普通外科研究所,江苏南京210002 [2]东南大学医学院,江苏南京210009

出　　处：《中国实用外科杂志》2025年第3期299-304,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.82272237,No.82270595);江苏省医学创新中心项目(No.CXZZ202217)。

摘　　要：肠空气瘘(EAF)伴腹壁毁损是一种复杂的外科并发症,严重影响病人的生存质量和预后。EAF的发生率在腹腔开放病例中可达8%~20%,并常伴有腹壁组织的广泛损伤。EAF的治疗依赖于分阶段的外科策略。初期目标是控制感染源,稳定病人全身状况,重点通过引流和抗生素治疗减轻腹腔污染,维持水电解质平衡和营养支持。中期主要是管理瘘口,通过引流、瘘口封堵、负压治疗等技术促进愈合,减少感染和电解质失衡。后期则实施确定性手术,恢复肠道连续性和腹壁结构,针对腹壁毁损程度选择合适的修复策略。新兴技术,如3D打印肠瘘支架、生物补片及智能材料,已在治疗中显示出良好的前景。研究结果表明,个体化治疗方案结合现代技术的应用能够显著提高治疗效果,减少并发症,提高病人的生存率和生活质量。未来,随着技术的进一步发展,EAF的治疗将更加精准和个性化。Enteroatmospheric fistula(EAF)accompanied by abdominal wall defects represents a complex surgical complication that severely impacts patients’quality of life and prognosis.Its incidence ranges from 8%to 20%in cases involving an open abdomen and EAF is often associated with extensive damage to the abdominal wall tissues.The management of EAF relies on staged surgical strategies.The initial phase focuses on controlling the source of infection and stabilizing systemic conditions by improving drainage and antibiotic therapy to reduce intra-abdominal contamination and maintain fluid-electrolyte balance and nutritional support.The intermediate phase involves fistula management,employing techniques such as drainage,fistula occlusion,and negative pressure wound therapy to promote healing while minimizing infection and electrolyte disturbances.The definitive phase entails surgical reconstruction to restore intestinal continuity and abdominal wall integrity,with repair strategies tailored to the extent of tissue destruction.Emerging technologies,including 3D-printed enterocutaneous fistula stents,biological meshes,and smart materials,have demonstrated promising clinical potential.Studies indicate that personalized therapeutic protocols integrating advanced technologies significantly improve clinical outcomes,reduce complications,and enhance patients’survival rates and quality of life.Future advancements in technology are expected to enable more precise and individualized approaches to EAF management.

关 键 词：腹腔开放 肠空气瘘 腹壁毁损 瘘口封堵 外科重建 

分 类 号：R6[医药卫生—外科学]